Primary Health Care

First Contact (General Practice Services)

General Medical Services Subsidy System
First Contact funding rates

The General Medical Services subsidy system

The traditional way of funding general practice services has changed significantly since the establishment of PHOs. Before PHOs most GPs made claims for a General Medical Services (GMS) subsidy whenever they delivered a service to a patient who was entitled to a subsidy. GMS subsidies are only available for a consultation with a doctor (not a nurse) and are paid at a standard rate regardless of the type or the timing of the service. These subsidies still apply for people who are not enrolled in a PHO or when an enrolled person is seen away from their normal practice.

GMS subsidies for all children under six years are $35. For people who qualify for a Community Services Card or High Use Health Card the subsidy for an adult is $15 and $20 for a child aged six and over. Children aged six and over without a card are subsidised $15 while adults without a card are not entitled to any subsidy.

First Contact funding rates

Annual capitation rates for general practice services are based on the average number of visits that an individual of a given age and gender is expected to make in a year. These average expected visit rates are taken from GMS claiming data and, for those not entitled to GMS subsidy, from general practice surveys.

The annual capitation amount is calculated by multiplying the average expected visit rate by a notional amount for each visit. When the first PHOs were established in 2002, the notional amount for a child under six was set at $35 (the same as the GMS subsidy) and for other groups eligible for higher funding the amount was set at $25 (higher than the GMS subsidy). These amounts increase regularly in order to retain the value of the subsidy. As a result the per-visit notional amounts are now $39.70 (under six) and $28.36 (others).

The detailed rate calculations include an amount for the practice nurse subsidy (PNS) and an adjustment to reflect expected increased visits rates because of reduced charges.

View the current PHO Capitation Rates for First Contact Services.

Page last updated: 5 October 2007